What Causes the Accumulation of Fluid in the Ear?

Ear examination
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Fluid in the ear, also called serous otitis media (SOM) or otitis media with effusion (OME), is an accumulation of fluid behind the ear drum that can occur under any condition in which the auditory tube is impaired.

The auditory tube allows fluid to drain from the ear into the back of the throat. If the auditory tube becomes clogged, fluid will become trapped in the middle ear space. This fluid is called an effusion by your healthcare providers.

In addition to ear infections, the common cold and allergies can often lead to fluid in the ear if inflammation or mucous prevent the auditory tube from draining. Learn how to prevent this from happening, and how to diagnose and treat this if it does.

Causes

Anyone can get fluid in their ears, but it is much more likely to occur in children due to the anatomy of their auditory tube, which is smaller in diameter and more horizontal than the auditory tube of an adult. There are about 2.2 million cases in the U.S. each year, and about 90 out of 100 children will get fluid in their ears at some point before they reach 5 or 6 years old.

All cases of fluid in the ear are caused by some form of auditory tube dysfunction which prevents your eustachian tube from adequately draining. Common causes for developing fluid in the ear for both adults and children includes:

  • Enlarged sinus tissue, nasal polyps, tonsils and adenoids, or other growths which block the auditory tube (usually caused by chronic sinusitis)
  • Exposure to chemical irritants, especially cigarette smoke
  • Damage to the auditory tube from radiation for head and neck cancer or previous surgeries which may transect the auditory tube (rare)
  • Barotrauma to the ears (rapid changes in ambient air pressure such as occur when flying in an airplane or scuba diving)
  • Oral abnormalities that can be associated with Down syndrome or cleft palate

Symptoms

Symptoms of fluid in the ears can range in severity by individuals. In small children the condition is often said to be symptomless, though it is more likely children of this age are just unable to express any discomfort and in the absence of severe ear pain most symptoms go unnoticed by their caretakers.

For most adults experiencing fluid in the middle ear symptoms may be subtle, but some adults report constant ear pain and debilitating symptoms. Some adults and older children who have had persistent problems with chronic fluid in their ears can sometimes tell when the fluid has re-accumulated and they are in need of treatment. In general, symptoms of fluid in the ears may include:

    There are several conditions that cause similar symptoms to fluid in the ear or that may be present at the same time as fluid in the ear including:

    Diagnosis

    Because fluid in the ear is often asymptomatic, especially in children, it often goes undiagnosed. If your child has symptoms of fluid in the ear it is best to take them to a pediatrician or an otolaryngologist (ear, nose, throat specialist or ENT). A specialist may have access to better diagnostic equipment, but even more importantly their experience is necessary to recognize subtle clues that might mean you have fluid in your ears.

    Using an Otoscope

    The best method for diagnosing fluid in the ear is an examination of the ear using an otoscope or otomicroscope. Your doctor will most likely use an otoscope as these are more prevalent due to cost, although an otomicroscope may allow for more accurate diagnosis.

    Evaluating the ear with an otoscope is very simple and involves pulling back the ear and inserting the tip of the otoscope into the ear. This allows the doctor to visualize the ear drum (tympanic membrane). Experienced physicians may actually see either a fluid level behind the ear drum, a bubble or that the ear drum is immobile. Unfortunately, it is not always so clear and the only thing indicating fluid in the ear might be a slight retraction of the ear drum or a slightly abnormal coloration. For this reason it takes a skilled physician to diagnose fluid in the ear.

    Tympanometry Exam

    Fluid in the ear can be confirmed by another test called tympanometry. This test has some similarities to an exam using an otoscope in that the ear will be pulled back and the tip of the instrument, also called the speculum, will be placed in the outer portion of the ear canal. Your child (or you, if you're the patient) should try to hold very still during this test and avoid speaking or swallowing if possible.

    The instrument will measure the pressure inside of the ear, then generate a tone. The tympanic membrane will reflect a certain amount of sound back into the tympanometer, which is charted on a graph called a tympanogram. If there is fluid in the ear, the tympanic membrane will stiffen and an abnormal amount of sound will be reflected.

    Treatment Options

    Typically, treatment is not necessary for fluid in the ears. The fluid will usually drain on its own within a few weeks. However, if it does not, treatment will depend on several factors.

    • If the fluid is present for 6 weeks, treatment may include a hearing test, a round of antibiotics or further observation.
    • If the fluid is present after 12 weeks, a hearing test should be performed. If there is significant hearing loss, the health care provider may consider antibiotics or placing tubes in the ears.
    • If the fluid is still present after 4 to 6 months, surgical placement of ear tubes are probably necessary even if you are not experiencing hearing loss.
    • Adenoids may also need to be removed if they are large and causing significant blockage of the eustachian tube.

    Fluid in the ears can be present with or without an active infection. Antibiotics are of no use unless there is a current ear infection and will not be used. While antihistamines are useful in helping prevent chronic sinusitis that may be impacting drainage of your auditory tube, antihistamines are not recommended for treatment of fluid in the ear.

    High-risk children, including those suffering from developmental delays, may require treatment earlier. For children who do not require treatment, managing symptoms and waiting for the fluid to clear up on its own may be the best thing to do. Even among children who require surgical intervention, full recovery is almost always achieved.

    Prevention

    • Avoid cigarette smoke
    • Avoid known allergens
    • If your child is in daycare, consider taking him out or switching to a smaller daycare if he gets fluid in his ears frequently
    • Wash your hands and your child’s toys frequently
    • Avoid overusing antibiotics
    • Encourage breastfeeding if possible, even for just a few weeks. Infants who are breastfed get sick less often and are less likely to get ear infections even years later.
    • Stay up to date on vaccines. The pneumococcal vaccine (Prevnar) helps prevent the most common type of ear infections and the flu vaccine may help as well.

    Contrary to popular belief, getting water in a baby or young child’s ears, will not cause serous otitis media. Children who swim frequently and do not dry their ears adequately may get swimmer's ear, but this is a completely different condition.

    A Word From Verywell

    Fluid in your ear is a common problem, particularly for children in their early years. Whether you are an adult or a child, the fluid in your ear will likely resolve without treatment.

    If your symptoms have persisted for more than six weeks or are causing significant symptoms, however, you should see your doctor. Prolonged, untreated fluid in the ear can impact your quality of life and performance at school or work.

    Sources:

    American Academy of Otolaryngology-Head and Neck Surgery. Treating and Managing Ear Fluid. http://www.entnet.org/sites/default/files/uploads/PracticeManagement/Resources/_files/ome-treating-managing_cobranded.pdf.

    Otitis media with effusion. Medline Plus website. https://medlineplus.gov/ency/article/007010.htm. Updated August 31, 2016.

    Rosenfeld, RM, Shin, JJ, Schwartz, SR, Coggins, R, Gagnon, L, Hacker, JM ... Corrigan, MD. (2016).Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology– Head and Neck Surgery. 154(1S) S1–S4.

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